Cardiovascular diseases are a major cause of mortality and morbidity worldwide. In a sub Saharan Africa cardiovascular and other metabolic diseases including diabetes are increasingly causing significant socio-economic and health burden. The increase has severely affected our health care systems already struggling with the burden of tropical and communicable diseases. Patients with diabetes are 2-4 times likely to develop cardiovascular disease and/or stroke. Although the risk factors for cardiovascular disease among type 2 diabetes may be known, there is inadequate information concerning diabetic patients attending Kenyatta National Hospital (KNH).

To explore structure and process factors which influence patients' perception of quality inpatient psychiatric nursing care at Mathari hospital. This was a cross-sectional study of 236 inpatients selected by stratified random sampling. Competence to give consent was determined by a minimum score of 24 on Mini Mental State Examination. Patients were interviewed using a semi-structured questionnaire. Differences in proportions of variables were determined by calculating confidence interval and summary chi-squared statistics. P-values of < or =0.05 were considered significant. Majority of patients (87%) were aged 20-49 years with 43% having stayed in the ward for over a month. Structure factors related to patients' perception of care included physical environment, being happy with the way the ward looked was significantly related to satisfaction with care (chi(2) = 5.506, P = 0002). Process factors significantly related to patients' satisfaction with care included nurses providing patients with information on prescribed medicines (chi(2) = 10.50, P = 00012). Satisfaction with care was positively related to ability to recommend someone for admission in the same ward (chi(2) = 20.2, P = 00001). Structure and process factors identified as influencing patients' perception of care were physical environment and nurses' qualities that fit within the characteristics of Peplau's Interpersonal Relations Theory.

In-patient psychiatric units which play an important role in the management of patients with severe psychiatric disorders often lack structures and processes needed for quality nursing care. Patients' and Nurses' perception of care is an important indicator quality of care and should be assessed regularly (Campbell, 1999; Garry and Shannon, 1997). Yet such assessment has not been done in Kenya to evaluate standards of in-patient psychiatric nursing care despite complaints of inadequate structures and processes of care in a country where more than 25% of patients in a general out patient clinic suffer from mental disorders; And WHO having developed quality checklist for evaluation of psychiatric care (WHO, 1994). The purpose of this study was therefore to explore structure and process factors that influence the patients' and nurses' perception of quality in-patient psychiatric nursing care at Mathari hospital, Nairobi. Donbedians' (1966) Structure-Process-Outcome model of quality care and Peplau's (1952) Interpersonal Relationships Theories were the frameworks for this study. It was a descriptive, quantitative and qualitative study of a sample of 236 in-patients and 13 1 nurses selected by stratified sampling. One of inclusion criteria for patients was a score of 24/30 on the mini mental status assessment tool. Data were collected for two months using mainly semi structured questionnaires and observation checklist tools modified fro in Gigantesco (2003), Wallace (199S) and WHO (1994) and was analyzed using SPSS version 10. Differences in proportions were determined by calculation of confidence interval and summary chi square statistic. p-values of:S 0.05 were considered statistically significant. A major finding was that physical environment vias significantly related to nurses and patients' satisfaction (X2=l0.456, p=O.0012) and (X2=5.506, p=O.002) respectively. The use Interpersonal relations principles of Peplau (1952) was also found to have a positive influence on patients' and nurses perception of care. Overall WHO(l991) criteria of good quality standards "vas met by only 4 (,28.5%) out of fourteen wards. One of the recommendations by the researcher i:' that Hospital administration urgently improves structure and process factors cf care at Mathari Hospital in order to improve quality of patient care.

Cerebral venous sinus thrombosis is an uncommon yet potentially life threatening condition which is often under-diagnosed or misdiagnosed because of the variability of the clinical signs and symptoms. The imaging findings are often subtle thus the need for a high index of suspicion. The superior sagittal and transverse sinuses are the most frequently involved. The correct diagnosis of cerebral venous thrombosis relies on neuroimaging studies. The two cases reported highlight the fact that the radiologist may be the first clinician to suspect and diagnose this condition. This ultimately affects prognosis as early diagnosis and treatment reduces morbidity and mortality.

Cerebral venous sinus thrombosis is an uncommon yet potentially life threatening condition which is often under-diagnosed or misdiagnosed because of the variability of the clinical signs and symptoms. The imaging findings are often subtle thus the need for a high index of suspicion. The superior sagittal and transverse sinuses are the most frequently involved. The correct diagnosis of cerebral venous thrombosis relies on neuroimaging studies. The two cases reported highlight the fact that the radiologist may be the first clinician to suspect and diagnose this condition. This ultimately affects prognosis as early diagnosis and treatment reduces morbidity and mortality.